- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,726.59 / $2,726.59 / $3,266.76
| Professional | | $2,726.59 | $2,726.59 | $3,266.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.00 / $170.00 / $178.00
| Professional | | $170.00 | $170.00 | $178.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.66 / $1,383.21 / $2,024.29
| Facility | | $926.66 | $1,383.21 | $2,024.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.46 / $1,517.46 / $1,517.46
| Professional | | $1,517.46 | $1,517.46 | $1,517.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.66 / $1,383.21 / $2,024.29
| Facility | | $926.66 | $1,383.21 | $2,024.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.46 / $1,517.46 / $1,517.46
| Professional | | $1,517.46 | $1,517.46 | $1,517.46 |